摘要
目的系统评价不同药物及方案降钙素基因相关肽(CGRP)受体拮抗剂治疗偏头痛急性发作的有效性和安全性。方法检索中国知网、中国生物医学文献数据库、万方、维普、PubMed、The Cochrane Library、Embase数据库中相关随机对照试验(RCT),检索时限为各数据库自建库起至2023年3月31日。采用RevMan 5.3软件进行风险评估,采用Stata 16.0统计学软件进行网状Meta分析。结果纳入9项RCT,涉及9214例患者,共7种干预措施。网状Meta分析显示,在2 h疼痛消失率、2 h疼痛缓解率、2~24 h持续疼痛消失率、2 h正常功能恢复率、2~24 h持续疼痛缓解率方面,最优选择均为Rimegepant75mg口腔崩解片(ODT);在2 h不适症状消失率、2 h畏声消失率、2 h恶心消失率方面,最优选择均为Ubrogepant50mg口服片剂(TAB);在2~48 h持续疼痛消失率、2~48 h持续疼痛缓解率、2 h畏光消失率方面,最优选择均为Zavegepant10mg喷鼻剂(NS)。安全性,降低总不良反应、恶心、头晕发生率方面最优选择均为Ubrogepant25mgTAB。结论3种CGRP受体拮抗剂中,Rimegepant75mgODT为治疗偏头痛急性发作的最佳方案,其次为Zavegepant10mgNS;Ubrogepant25mgTAB不良反应最少。
Objective To systematically evaluate the effectiveness and safety of different regimens of calcitonin gene-related peptide(CGRP)receptor antagonists in the treatment of acute migraine attacks.Methods The relevant randomized controlled trials(RCTs)in the CNKI,CBM,WanFang,VIP,PubMed,The Cochrane Library and Embase from the inception of these databases to March 31,2023 were searched.The RevMan 5.3 software was used for risk assessment,the Stata 16.0 statistical software was used for network Meta-analysis.Results Nine RCTs were included,involving 9214 patients and seven intervention measures.The network Meta-analysis showed that the Rimegepant75mg orally disintegrating tablets(ODT)was the optimal choice in the pain disappearance rate after 2 h of medication,pain relief rate after 2 h of medication,sustained pain disappearance rate after 2-24 h of medication,normal functional recovery rate after 2 h of medication,and sustained pain relief rate after 2-24 h of medication;the Ubrogepant50mg oral tablets(TAB)was the optimal choice in the discomfort symptom disappearance rate after 2 h of medication,phonophobia disappearance rate after 2 h of medication,and nausea disappearance rate after 2 h of medication;Zavegepant10mg nasal spray(NS)was the optimal choice in the sustained pain disappearance rate after 2-48 h of medication,sustained pain relief rate after 2-48 h of medication and photophobia disappearance rate after 2 h of medication.Ubrogepant25mgTAB was the optimal choice with the lowest incidence of total adverse reactions,nausea and dizziness.Conclusion Among the three CGRP receptor antagonists,Rimegepant75mgODT is the optimal choice in the treatment of acute migraine attacks,followed by Zavegepant10mgNS,Ubrogepant25mgTAB had the least adverse reactions.
作者
卢铨广
徐文坚
黄强
LU Quanguang;XU Wenjian;HUANG Qiang(Xiaolan People's Hospital of Zhongshan,Zhongshan,Guangdong,China 528416)
出处
《中国药业》
CAS
2024年第8期48-56,共9页
China Pharmaceuticals
